OBJECTIVE In the trials, a substantial proportion of newborns who underwent therapeutic hypothermia (TH) had an adverse outcome after hypoxic-ischaemic encephalopathy (HIE). Cooled babies were noted to have fewer cerebral lesions on MRI but when present lesions were predictive of adverse outcome. We investigate the predictive value of cerebral MRI in babies who undergo cooling in the clinical setting outside of the clinical trials in a prospective UK cohort. RESULTS Of 75 babies recruited from four centres, neurodevelopment was available for 69 (92%) with 29% (20/69) being abnormal. The unfavourable MRI group (n = 22) had significantly lower motor (p < 0.001), language (p < 0.001) and cognition (p < 0.001) scores on Bayley-III assessment, compared to the favourable MRI group (n = 47). On multiple regression there was a significant relationship between basal ganglia and thalami abnormality and motor (p = 0.002), cognition (p = 0.011) and language (p = 0.013) outcomes. Half of the babies who had an MRI predictive of adverse outcome (11/22) had highest grade cerebral palsy. Cerebral MRI had 95% sensitivity, 94% specificity, 91% PPV and 98% NPV in predicting neurodevelopment. CONCLUSIONS In this clinical cohort, fewer children had adverse neurodevelopment after TH compared to the TH trials. However, half the children who had an MRI predictive of adverse ND outcome had the most severe form of cerebral palsy. In this cohort, cerebral MRI was found to be highly predictive of neurodevelopmental outcome.

中文翻译：

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在临床实践中，新生儿脑部 MRI 对治疗性低温后的神经发育结果具有高度预测性

目的 在试验中，相当一部分接受治疗性低温 (TH) 的新生儿在缺氧缺血性脑病 (HIE) 后出现不良结局。在 MRI 上注意到冷却婴儿的脑损伤较少，但如果存在损伤则预示着不良后果。我们在一个前瞻性英国队列中研究了在临床试验之外的临床环境中接受降温的婴儿的大脑 MRI 的预测价值。结果 在从四个中心招募的 75 名婴儿中，69 名 (92%) 的神经发育可用，其中 29% (20/69) 异常。与有利的 MRI 组（n = 47）相比，不利的 MRI 组（n = 22）在 Bayley-III 评估中的运动（p < 0.001）、语言（p < 0.001）和认知（p < 0.001）得分显着降低. 在多元回归中，基底神经节和丘脑异常与运动 (p = 0.002)、认知 (p = 0.011) 和语言 (p = 0.013) 结果之间存在显着关系。接受 MRI 预测不良结果的婴儿中有一半 (11/22) 患有最高级别的脑瘫。脑 MRI 在预测神经发育方面的敏感性为 95%，特异性为 94%，PPV 为 91%，NPV 为 98%。结论 在该临床队列中，与 TH 试验相比，TH 后出现不良神经发育的儿童较少。然而，接受 MRI 预测不良 ND 结果的儿童中有一半患有最严重的脑瘫。在该队列中，发现脑 MRI 对神经发育结果具有高度预测性。接受 MRI 预测不良结果的婴儿中有一半 (11/22) 患有最高级别的脑瘫。脑 MRI 在预测神经发育方面的敏感性为 95%，特异性为 94%，PPV 为 91%，NPV 为 98%。结论 在该临床队列中，与 TH 试验相比，TH 后出现不良神经发育的儿童较少。然而，接受 MRI 预测不良 ND 结果的儿童中有一半患有最严重的脑瘫。在该队列中，发现脑 MRI 对神经发育结果具有高度预测性。接受 MRI 预测不良结果的婴儿中有一半 (11/22) 患有最高级别的脑瘫。脑 MRI 在预测神经发育方面的敏感性为 95%，特异性为 94%，PPV 为 91%，NPV 为 98%。结论 在该临床队列中，与 TH 试验相比，TH 后出现不良神经发育的儿童较少。然而，接受 MRI 预测不良 ND 结果的儿童中有一半患有最严重的脑瘫。在该队列中，发现脑 MRI 对神经发育结果具有高度预测性。然而，接受 MRI 预测不良 ND 结果的儿童中有一半患有最严重的脑瘫。在该队列中，发现脑 MRI 对神经发育结果具有高度预测性。然而，接受 MRI 预测不良 ND 结果的儿童中有一半患有最严重的脑瘫。在该队列中，发现脑 MRI 对神经发育结果具有高度预测性。